Introduction: Healthy People 2010 encourages the promotion of tobacco interventions accessible to disenfranchised populations. Consistent with this objective, health promotion advocates have supported initiating tobacco interventions in the emergency department (ED), where these populations often present for routine or non-urgent healthcare. Nevertheless, ED patients are currently unlikely to receive any tobacco counseling or referral to tobacco treatment services. A multicenter, randomized clinical trial (RCT) establishing the feasibility and effectiveness of an ED-initiated tobacco intervention would help to promote the adoption of such efforts into routine clinical practice. Our proposal seeks to build capacity and to gather data on important parameters that do not currently exist in the published literature but which are deemed vital to designing and executing such an ambitious trial. Specific Aims: The proposal includes three separate studies that help us to determine: (1) the prevalence of smoking among adult ED patients, interest in quitting, and patient preferences pertaining to ED-initiated tobacco interventions; (2) the prevalence and predictors of cessation after the ED visit under treatment-as-usual conditions; and, (3) ED healthcare providers' insights and recommendations for the structure, processes, and logistics of ED-initiated tobacco interventions. Methods: Study One, a Qualitative Study, will consist of four focus groups designed to explore the features, processes, and logistics of ED-initiated tobacco interventions from the perspective of ED healthcare practitioners and actual ED patients who smoke. Study Two, a Cohort Study, will be conducted at ten EDs representing diverse geographic regions. Powered to detect a 6-12% rate in sustained abstinence at 6- months, a total of 362 smokers will undergo an initial 20-minute Baseline Assessment in the ED. This assessment will collect data on a range of potential predictors, including demographics, nicotine dependence, readiness to change, self-efficacy, and perceived health impact. Follow-up Assessments will be conducted by telephone 14-days, 3-months, and 6-months post-visit. Primary outcomes will consist of sustained abstinence, 7-day point prevalence abstinence, and any quit attempt lasting >=24 hours. Secondary outcomes will consist of nicotine dependence, readiness to change, relapse curves for those attempting to quit, and tobacco treatment initiation. Study Three, the Healthcare Provider Survey Study, will use a structured questionnaire to assess approximately 500 ED healthcare providers' opinions and practices related to tobacco screening, assessment, and interventions. Significance: This proposal will not only prepare the way for a multi-center RCT in the ED setting, it will also enhance our understanding of tobacco use and cessation among underserved demographic groups. [unreadable] [unreadable] [unreadable]